实时超声弹性成像对强直性脊柱炎患者跟腱损伤的评估价值

摘要

目的：对比健康志愿者（HC）与强直性脊柱炎（AS）患者跟腱实时超声弹性成像（SE）声像图表现，探讨 SE对 AS 患者跟腱损伤的评估价值。方法：对30例 HC 和30例 AS 患者（包括可能 AS 患者）双足跟腱行二维及 SE 检查，将跟腱分为三段：近段（肌肉肌腱结合部）、中段（跟骨嵌入处上方2~6 cm）、末段（跟骨嵌入处），每段跟腱均进行横断和纵断扫查。二维观察跟腱的厚度、宽度、内部回声及起止点病变表现，记录结果分为Ⅲ级：Ⅰ级正常跟腱（平行整齐的边缘、内部回声均匀）、Ⅱ级轻度病变的跟腱（不平行弯曲的边缘、内部回声均匀）、Ⅲ级有明显病变的跟腱（内部有低回声区、起止点病变特点）。SE 检查结果同样分为Ⅲ级：Ⅰ级正常跟腱呈均一的蓝色或绿色，Ⅱ级跟腱轻度变软呈黄色，Ⅲ级跟腱明显变软内部有红色软化区。结果：二维记录跟腱三段的宽度和厚度，计算厚/宽比，两组之间近段差异无统计学意义（P =0.495），末段和中段差异有统计学意义（P <0.001，P =0.001）；二维发现的跟腱三段异常病例数在两组之间差异均无统计学意义（P =0.298，P =0.464，P =0.315）；SE 发现的跟腱中段和近段异常病例数在两组之间差异无统计学意义（P =0.224，P =0.315），末段两组之间差异有统计学意义（P =0.001）；二维和 SE 在检测跟腱三段病变之间具有较好的一致性（Κ=1.000，Κ=0.674，Κ=0.574）；AS 患者跟腱异常部位多发生在末段，而 HC 跟腱异常多发生在中段。结论：SE 在评价跟腱异常方面与 B 型超声有较好的相关性，并且比 B 超敏感，SE 可能成为监测 AS 患者病情和治疗效果以及评估其他风湿免疫类疾病的新方法。%Objective:Real - time sonoelastography(SE)was performed in healthy controls(HC)and patients with anky-losing spondylitis(AS)and the results was contrasted. To investigate the efficacy of SE for assessing achilles tendon abnormali-ties. Methods:B - mode ultrasound and SE was longitudinally and transversely performed in achilles tendons of 30 asymptomat-ic healthy controls and patients with AS. Tendon was divided into proximal(musculotendinous junction),middle(2 ~ 6 cm a-bove insertion at the calcaneus)and distal( insertion at the calcaneus)segments. B - mode examinations included tendon thicknesses,widths,echotextures,and enthesopathic findings. Ultrasound images were graded into three grades:grade 1,normal- appearing tendon( parallel margins,homogeneous echotexture);grade 2,enlarged tendon( bowed margins,homogeneous echotexture);grade 3,hypoechoic area with or without tendon enlargement. SE images were evaluated by the following experi-mentally proven color grading system:grade 1,blue(hardest tissue)to green(hard tissue);grade 2,yellow(intermediate tis-sue);grade 3,red(soft tissue). Results:B - mode recorded the thickness and width of every segment of achilles tendon,then calculated the thickness and width ratio. No significant differences was observed in proximal segment between the 2 groups(P= 0. 495),meanwhile patients with AS performed significant differences with HC at distal and middle segment(P < 0. 001,P =0. 001). The number of abnormal cases of each segment detected by B - mode is not statistically significant between the 2 groups( P = 0 . 298 ,P = 0 . 464 ,P = 0 . 315 ),neitherinproximalandmiddlesegmentbetween2 groupsexaminedbySE( P =0. 298,P = 0. 464,P = 0. 315). There is significant differences in distal part between 2 groups examined by SE(P = 0. 001). B - mode and SE were moderately to well correlated with regard to assessing Achilles tendon abnormalities( Κ = 1 . 0 0 0 ,Κ =0. 674,Κ = 0. 574). Interesting,SE abnormalities were more common in the middle third of the Achilles tendon in the HC group and in the distal third of the Achilles tendon in the AS group. Conclusion:SE and B - mode were moderately to well cor-related with regard to assessing Achilles tendon abnormalities and SE has superior sensitivity in assessing Achilles lesions com-pared with B - mode. SE may be a new valuable method for detecting AS activity or treatment effect and assessing other inf lammatory rheumatic disorders.